Provider Demographics
NPI:1083648257
Name:WOOD, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N COIT RD STE 3040
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5418
Mailing Address - Country:US
Mailing Address - Phone:972-238-8092
Mailing Address - Fax:972-238-8093
Practice Address - Street 1:970 N COIT RD STE 3040
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5418
Practice Address - Country:US
Practice Address - Phone:972-238-8092
Practice Address - Fax:972-238-8093
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039413203Medicaid
TX039413204Medicaid
TX8522B0Medicare ID - Type Unspecified
TX039413203Medicaid
TX8L5265Medicare PIN
TX039413204Medicaid
TX8L2129Medicare PIN